Vertigo is the sensation of spinning or movement when a person is standing still. This differs from general dizziness or lightheadedness, which feels like fainting or unsteadiness. While most vertigo originates in the inner ear and is benign, a brain tumor can cause this spinning sensation, though this is rare. Understanding the difference between a peripheral (inner ear) and a central (brain-related) cause is important for proper medical evaluation.
How Brain Tumors Disrupt Balance
The body’s sense of balance is maintained by a complex system connecting the inner ear’s vestibular organs with the brainstem and the cerebellum (the coordination center). A tumor disrupts this system by occupying space and placing pressure on these structures.
Tumors in the cerebellum interfere with movement coordination, causing balance problems and unsteadiness. A mass near the brainstem can compress pathways transmitting balance signals, distorting the information the brain receives. This results in a persistent sense of motion or spinning.
Acoustic neuromas (vestibular schwannomas) frequently cause vertigo. These benign tumors develop on the vestibular nerve, compressing it as they enlarge. Other tumor types, such as meningiomas and gliomas, can also cause vertigo if their location affects the vestibular pathways.
Common Causes of Vertigo That Are Not Tumors
The vast majority of vertigo cases originate in the inner ear, unrelated to a brain mass.
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is the most common cause, triggered by specific changes in head position. It occurs when tiny calcium carbonate crystals (otoconia) become dislodged and migrate into the semicircular canals. These displaced crystals send false signals of movement to the brain, resulting in brief, intense episodes of vertigo lasting less than a minute.
Inflammatory Conditions
Vestibular Neuritis or Labyrinthitis involves inflammation of the inner ear or the vestibular nerve, often following a viral infection. Neuritis causes sudden, severe, and continuous vertigo, nausea, and imbalance, without affecting hearing. Labyrinthitis presents with vertigo alongside new hearing loss and tinnitus. These conditions usually resolve over a few weeks or months.
Meniere’s Disease and Migraines
Meniere’s Disease is a chronic inner ear condition characterized by fluid buildup. Symptoms include recurrent episodes of severe vertigo lasting 20 minutes to several hours, fluctuating hearing loss, tinnitus, and a feeling of fullness in the ear. Vestibular Migraines are a neurological condition causing episodes of vertigo and dizziness.
Warning Signs and Associated Symptoms
Central vertigo, caused by a brain tumor, presents differently than common inner ear issues. A significant warning sign is vertigo that is persistent and does not resolve, or unsteadiness that is constantly worsening. This differs from the episodic nature of BPPV or the temporary duration of viral conditions.
New, severe, or persistent headaches, especially if worse in the morning, are a cause for concern. Symptoms pointing to broader neurological involvement include difficulty walking, gait instability, double vision, or involuntary eye movements.
Other signs requiring prompt medical attention include numbness, tingling, or weakness affecting one side of the body, slurred speech, or difficulty swallowing. If the tumor is an acoustic neuroma, the vertigo may be accompanied by gradual or sudden hearing loss and tinnitus restricted to one ear.
Medical Evaluation and Diagnosis
Evaluation of persistent vertigo begins with a thorough medical history to understand the nature of the spinning sensation, including triggers and associated symptoms. A physician performs a detailed neurological examination to check balance, coordination, and cranial nerve function. Initial tests include bedside maneuvers, such as the Dix-Hallpike test, designed to diagnose common conditions like BPPV.
Audiograms are routinely performed to check for hearing loss, which helps distinguish between different causes of vertigo. If the physical exam suggests a central cause or neurological red flags are present, brain imaging is necessary.
Magnetic Resonance Imaging (MRI) is the preferred method for visualizing the brainstem and cerebellum, providing high-resolution images to rule out a mass or structural issue. A Computed Tomography (CT) scan may be used if MRI is unavailable, though it is less sensitive for detecting smaller lesions.